End of story on small group coverage and corporate wellness?

Following the suspense of Supreme Court rulings last June and the drama of election-year posturing, the press has introduced a cliff-hanger for health care reform: a loophole that could allow some businesses to drop coverage without paying fees. This increases the likelihood of an influx of individuals to the health insurance exchanges, which could affect operations for health plans and corporate wellness vendors alike.

Like a good mystery, the clues have been laid out for us all along, but it’s a January 30 editorial from the Wall Street Journal that puts them together for full impact. Columnist Paul Christiansen suggests that employers required to offer insurance (those with more than 50 employees) can exempt themselves from this obligation by shifting away from full-time employment arrangements.

Instead, corporations’ employment structures can be arranged as a set of contracts with firms that provide their human resources. In his January 30 article for the Health Care Blog, Jaan Sidorov, primary care internist and former medical director at Geisinger Health Plan, points out that this is most feasible for small and mid-sized companies. This makes those groups most likely to take advantage of the strategy.

This argument makes a relatively strong case for anticipating a small-business employee exodus to the exchanges, but that outcome remains far from certain. The IRS and the administration will, no doubt, take whichever preventive actions they can.

But if businesses see in this an attractive opportunity to save money, or if it seems likely that similar strategies will come to light, health plans would do well to counter by offering compelling value-add services. Secondary to price, network and scope of benefits, enhancements to integrated wellness could be a workable strategy.

These programs appeal to healthy non-claimants as well as those with medical conditions. If the small-group wellness product on offer is scalable and cost-effective, without compromising on engagement, it may be successful in both retention and prospecting efforts for health plans.

I intend to keep an eye on developments regarding the “shared responsibility” loophole. The conclusion has ramifications for health management providers as well as payers and plans. HealthFitness has delivered services on a record scale this year. Our solutions have remained attractive for employers preparing for reform, and we will continue to grow with our clients partly by keeping on top of the changes and staying flexible. How about you? Do you feel ready for the next chapter?

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Glenn is vice president of business development. He consults with health plans to design competitive health management solutions for their respective market. He brings more than 20 years of experience in the health industry, working in business development for health plans, incentives and pharmaceuticals.